By Paulina De Cesare

The concept of Digital Health is on the agenda of the Comisión Económica para América Latina y el Caribe (CEPAL). In fact, as part of the Action Plan set out at eLAC2015 and the Statistics Conference of the Americas, the organization has been developing a set of indicators to help states in the region monitor the incorporation of information and communication technologies (ICT) in the health sector.

For its part, the Social Development Division is providing technical assistance to evaluate the impact of current policies and strategies on the population and healthcare organizations.

The sociologist Andrés Fernández∴, an official in Social Affairs and coordinator of Digital Health at CEPAL, is revising eHealth policies in Latin America and analyzing how certification systems should function in the region.

In Latin America, there is increasing debate over the role of ICTs, how does this trend affect the healthcare sector? 

There has been a notable change compared to six or seven years ago. Today there isn’t just a technical debate but also a political one over ICTs in the health sector. This has made it possible to reformulate some of the strategies for developing projects. For example, it is already common for representatives of the public health sector to take part in seminars on digital health participation, something that didn’t happen so much before.

You mentioned that many countries are reformulating their strategies. However, in practice, there are still examples of resistance to change. Why is this?  

Costs are a significant barrier but not so much because they are high as because there isn’t yet enough knowledge about the benefits of the technology. The ability to envision these benefits depends very much on the vision that the countries develop. I believe that it should be focused on reducing the gap in access to healthcare and increasing demand due to the prevalence of non-communicable chronic diseases.

For now, many healthcare ministries are focused on resolving needs related to administration. And it is fine to address needs but that doesn’t mean we should ignore the important things, for example improving the capacity to provide primary healthcare.

As we manage to increase this capacity with ICTs, we will reduce the gap in access and the pressure on hospital care. But we must also keep in mind the need to monitor chronic patients. ICTs are key tools in answering these challenges.

Is the preoccupation over the privacy of data commensurate with the actions implemented with regard to certification and patient safety? 

No, we’re quite far behind, it’s one of the pending issues that still requires regulation. The same is true of unique identification of patients and the transfer of clinical information between the public and private sectors, which requires a regulatory framework.

If no satisfactory regulatory framework for privacy exists, there is always the risk of mixing health information with other kinds of information; that which belongs to patients.

So, to improve the functioning of clinical information systems, don’t we need to develop a public certification  system?   

Yes, we’ve seen certification systems in the private sector because they include these elements to compete in the healthcare market but they’re still lacking in the public sector.

In the case of developing a system, the focus on certification should be based more on results than facilities or technological advances. Although it’s true that these advances make better results possible, for the public sector it is more relevant to identify the expected results and how far healthcare units are improving.  

In recent years, Chile has placed great importance on the concept of Connected Healthcare through the development of its SIDRA strategy. What aspects of this experience can be used as points of reference by other countries in the region?

In my opinion, the SIDRA program has one notable element: it has developed an extensive perspective and a systematic vision. And within this vision the Electronic Health Record plays an important role as does the National Data Repository, which are very important elements in favoring the continuity of clinical care. However, it is important to make progress with data sharing between the public and private sectors, because people receive treatment from both. That, I insist, should be approached during the creation of a regulatory framework because it includes the issue of information privacy.

∴ Andrés Fernández  is a sociologist. He graduated from the Universidad de Chile and has a post-graduate degree in Training and Evaluation of Investment Projects. Currently, he is the coordinator of Digital Health in the Social Development Division of the Economic Commission for Latin America and the Caribbean (CEPAL).

He has also worked with the Pan-American Health Organization (WHO) on the formulation of a regional eHealth strategy and the development of regional protocols for public policy on Telehealth in Brazil.

He has published the books Salud electrónica en América Latina y el Caribe: Avances y desafíos (Electronic Healthcare in Latin American and the Caribbean and Tecnologías de la información y la comunicación en el sector salud: oportunidades para reducir inequidades en América Latina y el Caribe (Information and Communication Technologies in the Healthcare Sector: opportunities to reduce inequities in Latin America and the Caribbean)  and coordinated the development of the Electronic Healthcare Manual for Directors of Healthcare Services and Systems.

At the HIMSS Chile Conference and Exhibition, Fernández will take part in the panel “Certification for Chile and Latin America,” which will take place on December 1.